title: The association of waiting times from diagnosis to surgery with survival in women with localised breast cancer in England.
abstract: BACKGROUND
  Survival from breast cancer in the United Kingdom is lower than in other developed countries. It is unclear to what extent waiting times for curative surgery affect survival.
  
  
  METHODS
  Using national databases for England (cancer registries, Hospital Episode Statistics and Office of National Statistics), we identified 53 689 women with localised breast cancer, aged ≥ 15 years, diagnosed between 1996 and 2009, who had surgical resection with curative intent within 62 days of diagnosis. We used relative survival and excess risk modelling to determine associations between waiting times and 5-year survival.
  
  
  RESULTS
  The median diagnosis to curative surgery waiting time among breast cancer patients was 22 days (interquartile range (IQR): 15-30). Relative survival was similar among women waiting between 25 and 38 days (RS: 93.5%; 95% CI: 92.8-94.2%), <25 days (RS: 93.0%; 95% CI: 92.5-93.4%) and between 39 and 62 days (RS: 92.1%; 95% CI: 90.8-93.4%). There was little evidence of an increase in excess mortality with longer waiting times (excess hazard ratio (EHR): 1.06; 95% CI: 0.88-1.27 comparing waiting times 39-62 with 25-38 days). Excess mortality was associated with age (EHR 65-74 vs 15-44 year olds: 1.23; 95% CI: 1.07-1.41) and deprivation (EHR most vs least deprived: 1.28; 95% CI: 1.09-1.49), but waiting times did not explain these differences.
  
  
  CONCLUSIONS
  Within 62 days of diagnosis, decreasing waiting times from diagnosis to surgery had little impact on survival from localised breast cancer.
authors.affiliation: School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK. theresa.redaniel@bristol.ac.uk
authors.forename: M T
authors.initials: MT
authors.lastname: Redaniel
authors.forename: R M
authors.initials: RM
authors.lastname: Martin
authors.forename: S
authors.initials: S
authors.lastname: Cawthorn
authors.forename: J
authors.initials: J
authors.lastname: Wade
authors.forename: M
authors.initials: M
authors.lastname: Jeffreys
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D004739:England; D005260:Female; D006801:Humans; D008875:Middle Aged; D016019:Survival Analysis; D061665:Time-to-Treatment; D055815:Young Adult